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Dr. Leon Rosenthal writes:
...I believe that your summary is a good reflection of what we intended to communicate...There are a couple of comments that are pertinent to your discussion of the paper:
1. The Multiple Sleep Latency Test (MSLT) is the best validated tool in measuring daytime sleepiness...However, the meaning of these scores in the real world (i.e., the likelihood of falling asleep when driving) have not been researched...Despite these limitations...the MSLT (in the context of the clinical and laboratory evaluation) is very useful in determining the significance of excessive daytime sleepiness.
2. Your comments about the apparent loss of sleep homeostasis in patients with severe sleep apnea are also on target and very relevant to the main findings of this paper. There is no question that for the patient with severe apnea the main goal is to restore breathing during sleep. However, from the clinical point of view it is always important to remind patients about the importance of spending enough hours in bed in order to meet their heomeostatic sleep need. This is particularly relevant when discussing CPAP treatment and issues related to treatment compliance in this patient population.
What this viewer seems to be suggesting is that, at least for mild to moderate sleep apneics, time spent napping may be more productive of continuous, slow-wave sleep than extending the period of nighttime sleep. This would follow from the observations that arousals related to respiratory events occur most often during REM periods, which take up a greater proportion of sleep as the night proceeds. Except in narcoleptics, REM periods do not normally occur during naps, perhaps because naps do not generally last long enough to complete the 90-minute cycle leading into REM. Slow-wave sleep does occur during naps, especially in sleep-deprived individuals, and especially with naps occuring later in the day. On the other hand, slow-wave sleep obtained in naps may only reduce the amount of slow-wave sleep experienced the subsequent night.
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AUTHORS’ COMMENTS
One Viewer’s Interesting Thought:
May I suggest a possible alternate hypothesis to explain the greater alertness of mild to moderate apneics after napping? Since stages three and four sleep are of greater length in the first hours of sleep (take up a greater
proportion of the early sleep cycles), would not a nap (or multiple naps) produce the optimum amount of beneficial sleep, assuming that severe apneics are unable to reach or maintain stages three and four?
My Response:
To me, the situation remains confusing enough that I would hesitate to make predictions, but the viewer’s point that naps may represent a better way for mild to moderate sleep apneics to make up for fragmented nighttime sleep than extension of the night’s sleep seems plausible and testable.
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